Predicting Factors of Nonsentinel Lymph Node Metastasis in Breast Cancer Patients with Sentinel Lymph Node Metastasis

PURPOSE: The purpose of this study was to investigate the predictors of nonsentinel lymph node (NSLN) metastasis in breast cancer and to evaluate the usefulness of the scoring systems and nomograms. METHODS: In this analysis, we reviewed the clinicopathologic features of 70 patients who had undergone sentinel lymph node (SLN) biopsy and axillary lymph node dissection. The clinical features of patients, histologic parameters and hormonal receptor status of primary tumor and histopathologic features of SLN metastasis were noted retrospectively. Furthermore, the receiver operating characteristic (ROC) curve was drawn and the area under the ROC curve (AUC) was calculated to assess the discriminative power of the scoring systems and nomograms. RESULTS: The metastatic tumor size in SLN (P<0.001), extracapsular invasion (P=0.002), percentage of positive SLNs among the removed SLNs (P=0.011), primary tumor size (P=0.038) were associated significantly with NSLN metastasis, statistically, in univariate analysis. Based on multivariate logistic regression, the metastatic tumor size was the only prognostic factor of NSLN metastasis (P=0.012). The AUC of Memorial Sloan-Kettering Cancer Center scoring system was greater than other systems, significantly (P=0.004). CONCLUSION: We have shown in this study that it would be possible to predict NSLN status based on the metastatic tumor size in SLN. Although the significance was not achieved in multivariate analysis, the size of primary tumor, extracapsular invasion of metastasis in SLN, percentage of positive SLNs among the removed SLNs had the potential to be a predictive factor of NSLN metastasis. MSKCC scoring system appears to be more effective and accurate than other scoring systems for selecting patients for whom axillary lymph node dissection can be avoided.

Pathological Correlation of Re-excised Breast Lesions after the use of the Ultrasound-Guided Vacuum-Assisted Biopsy Device (Mammotome(R)) / 한국유방암학회지

PURPOSE: The Mammotome(R) biopsy is a relatively new surgical technique that is a minimally invasive image-guided procedure, requiring a small incision that produces a barely noticeable scar. The technique is a useful method for the surgical biopsy of properly selected patients. We reviewed the pathology of the biopsies for the proper selection of a mammotome biopsy in patients with re-excised breast tumors. METHODS: During a 24-month period, we performed vacuumassisted breast biopsies for 277 likely benign breast lesions using ultrasound and fine-needle aspiration cytology or a core needle biopsy, in 203 patients. The age of the patients ranged from 15 to 67 yr (average age 36.6 yr), and the average size of the lesions was 2.39+/-1.06 cm (minimum size 0.5 cm, maximum size 5.0 cm). We retrospectively analyzed the pathological findings of the re-excised breast lesions. RESULTS: The pathology of ultrasound-guided vacuum biopsies of the benign-appearing breast lesions were fibroadenomas (69.7%), intraductal papillomas (6.1%), fibrocystic disease (7.9%), phyllodes tumors (2.9%), malignant tumors (1.4%), ductal hyperplasia (2.9%), and other benign diseases (9.1%). Re-excision by a conventional method was performed for nine patients. Reasons for re-excision were the presence of five proven malignancies (a malignant phyllodes tumor in 2 cases, a tubular carcinoma in 1 case, a papillary carcinoma in 1 case and a ductal carcinoma in situ [DCIS] in 1 case), a possible atypical ductal hyperplasia (ADH) malignancy, two marginal involvement in phyllodes tumors and the possible extension of a lesion as an atypical papilloma. In the re-excised specimens, residual tissues were noticed in eight cases. An ADH lesion was proven as a DCIS. CONCLUSION: A case of suggested marginal involvements and/or a possible malignancy should be re-excised because of the high possibility of remnant lesions being present after the mammotome biopsy. The cytological and pathological review must be performed precisely before performing the mammotome procedures with considering of the clinical and radiological findings.

A Case of Simple Hepatic Cyst Complicated by Intracystic Hemorrhage

Simple liver cysts are common and benign lesions, and most of them are detected by ultrasonography (US) or computed tomography (CT) during a medical checkup. Because simple liver cysts are generally asymptomatic, they do not require treatment, although hemorrhage, infection or rupture may occur in rare cases and these cases must receive proper treatment. The diagnosis of simple liver cysts is usually easy because of their typical morphological findings on US or CT. However, when a liver cyst contains hemorrhage or it is inflamed on imaging studies, it is sometimes difficult to differentiate simple hepatic cysts from such conditions as cystadenoma and cystadenocarcinoma. In this report, we describe a case of simple liver cyst that was complicated by intracystic hemorrhage, and this malady was initially diagnosed as biliary cystadenocarcinoma. We successfully treated this lesion by left lateral segmentectomy.

Experimental Study of 99mTc-Ciprofloxacin (Infecton) Imaging for the Diagnosis of the Acute Appendicitis

PURPOSE: Acute appendicitis is the most common disease requiring abdominal surgery, but for atypical clinical findings, a preoperative diagnosis is difficult and the frequency of a false positive and false negative diagnosis is high. The authors compared the diagnostic accuracy of a Technetium-99m-ciprofloxacin scan with that of the other diagnostic tools and evaluated its potential for clinical applications. METHODS: Seventeen patients were among those patients who visited the emergency room due to right lower quadrant (RLQ) pain were selected for this study. The decision for primary treatment was based on the clinical findings (RLQ pain, nausea, tenderness, rebound tenderness, leukocytosis, etc) and the radiological findings (abdominal ultrasonogram, abdominal computed tomography, etc). The 99mTc-ciprofloxacin scan was conducted regardless of the decision above. For the patients who underwent surgery, the final diagnosis of acute appendicitis was based on the pathologic result and for patients who did not undergo surgery, the final diagnosis was determined by the clinical course. RESULTS: Seventeen patients were enrolled in this study (7 males, 10 females). The patient's age ranged from 8 to 71 years and the average age was 29.2 years. The diagnostic accuracy of acute appendicitis is presented in order of the clinical findings, the radiological findings and the 99mTc- ciprofloxacin scan as follows: The sensitivity was 100%, 90.9% and 100%; the specificity rates was 33.3%, 50% and 67%; the positive predictive value was 87.5%, 90.9% and 93%; the negative predictive values was 100%, 50% and 100%; the false positive rate was 66.7%, 50% and 33.3%; the false negative rate was 0%, 9% and 0%. The respective p-values for the correlation between these results and the final diagnosis were 0.021, 0.049 and 0.002. CONCLUSION: A 99mTc-ciprofloxacin scan can decrease the false positive and the false negative rate and increase the diagnostic accuracy of acute appendicitis patients.